Primary Mediastinal Large B-Cell Lymphoma during Pregnancy

Abstract

Non-Hodgkin's Lymphoma (NHL) rarely presents during pregnancy and primary mediastinal large B-cell lymphoma (PMLBCL) accounts for approximately 2.5% of patients with NHL. The case of a 22-year-old woman who was diagnosed with Stage IIA PMLBCL during week 13 of her intrauterine pregnancy is described. The staging consisted in computed tomography (CT) of the chest and magnetic resonance imaging (MRI) of the abdomen and pelvis. She was managed with R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for a total of six cycles and, because of the early presentation during the second trimester, she received the entire chemotherapy course during the pregnancy. She delivered a healthy baby at 34 weeks of pregnancy and a 18FDG-PET/CT scan demonstrated complete remission after delivery. After 20 months of follow up she remains with no evidence of disease and her 1-year-old son has shown no developmental delays or physical abnormalities. PMLBCL, although an uncommon subgroup of DLBCL, may present during pregnancy and R-CHOP should be considered as one suitable option in this complex scenario.

Are biological drugs safe in pregnancy?

“…In this respect the London Position Statement of the World Congress of Gastroenterology on the Biological Therapy for IBD stated that vaccination of infants exposed to biological therapy in utero should be given according standard schedules, except for live-virus vaccines, which are not recommended if biological agents are detectable in the infant bloodstream (71). Table III summaries the reports of maternal exposure to rituximab either prior to or during pregnancy (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Rituximab has various indications.…”

Anaplastic large cell lymphoma in a pregnant Filipino woman successfully treated with prepartum and postpartum chemotherapy

“…In these earlier reports, preterm delivery was either induced,22 or the patient had preterm labour 20 23. Whether this is due to the chemotherapy or the monoclonal antibody is not entirely clear.…”

Management of Concurrent Pregnancy and Acute Lymphoblastic Malignancy in Teenaged Patients: Two Illustrative Cases and Review of the Literature

“…Perez et al 4 Journal article Case report of non-Hodgkin lymphoma treated with aggressive combination chemotherapy (R-CHOP) in 2nd trimester with good outcome of pregnancy, baby, and primary disease 1-year post-delivery.…”

“…1 To our knowledge, there is no available information about the incidence of lymphoblastic lymphoma during pregnancy, but the estimated general incidence of non-Hodgkin lymphoma is 0.8 cases per 100,000 pregnancies. [2][3][4] ALL and advanced-stage lymphoblastic lymphoma have a very good prognosis in children and teenagers, and are currently treated on similar protocols. 5 However, there are no available guidelines for the management of these cancers in pregnant young patients aged 21 years and younger.…”

“…27 However, most reported cases have involved combination chemotherapy, and several studies have documented safe maternal and fetal outcomes after standard cyclophosphamide-containing regimens for aggressive lymphomas during pregnancy. 2,4,13,19,20 Cytarabine exposure during the first trimester has been found to pose an 11% risk of congenital anomalies, 27 while second-and third-trimester exposure is associated with increased risk of prematurity, low birth weight, and possibly intrauterine fetal demise. 12,26 Imatinib, the prototype tyrosine kinase inhibitor, has been teratogenic in animal studies.…”